Size Matters in Antibiotic Overuse

Smaller hospitals appear to be more often guilty of giving patients antibiotics they don't need. Help may be on the way from the CDC.

This week's news that far too many hospitals give patients antibiotics they don't need—with prescription error rates as high as 40%—illustrates the urgent need for the CDC's "seven critical components" stewardship program.

Between 20% and 50% of the antibiotics given to patients in hospitals are either unnecessary or inappropriate. The Centers for Disease Control and Prevention director, Tom Frieden, MD, is worried the nation needs to "step back from the brink" of having no drugs to treat resistant bacteria.

But lest we lose all the drugs in our quiver, and resistant bacteria and Clostridium difficile toxins spiral out of control to kill us all, there may be strategic ways to tackle the problem where it lives very soon.

The new CDC report indicates that variation in prescribing practices is enormous, with some hospitals prone to give antibiotics as much as three times more often than other hospitals, despite a similar patient mix.

So it's not all hospitals and all doctors flagrantly ignoring good antibiotic stewardship practices. All we need now is to determine which hospitals and which doctors need an aggressive intervention, zoom in to reeducate their teams, and change prescribing protocols. Simple—well, probably not.

Size Matters

But here's a clue. Is it possible, I wondered, that doctors who aren't observing good prescribing practices are more likely located in smaller, perhaps rural, or critical access hospitals? Might these facilities lack access to rapid, sophisticated lab equipment to identify the type of bugs their patients bring in?